Medicare is a government health insurance program for eligible individuals. To be eligible you must be: 65+ years old; have collected SSDI benefits for more than 24 months; or have been diagnosed with end stage renal disease (ESRD) or ALS. Medicare coverage is broken up into “parts:”
- Part A: Hospital Insurance – includes hospital care, skilled nursing facilities, nursing homes, hospice, and home health services.
- Part B: Medical Insurance – includes services from doctors, preventive care, outpatient care, lab tests, mental health care, ambulance services, and durable medical equipment.
- Part D: Prescription Drug Plan (PDP) – different plans to choose from depending on where you live, with different premiums and formularies.
- Part C: Advantage Plans. Part C is an alternative to Parts A & B and it includes the benefits and services covered under Parts A & B, and usually Part D. You can select a PPO or HMO plan that is run by a Medicare approved private insurance company.
You can enroll in Medicare for the first time during Initial Enrollment Periods, when:
- You’re newly eligible for Medicare because you turn 65. You get a 7-month period to pick your plans, which starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
- You’re newly eligible for Medicare because you’re disabled and under 65.
- You’re already eligible for Medicare because of a disability, and you turn 65.
- You are working and receiving insurance through your work, you can enroll up to 8 months after you stop working.
If you fail to enroll during these windows, you can enroll during the General Enrollment Period (GEP), which is January 1st through March 31st, every year. However, if you sign up during the GEP, but were eligible earlier than that, you could be facing a Medicare Part B late enrollment penalty.
Most people receive their Part A coverage at no cost, but they do have pay for Part B coverage. Since Part B is something you pay for, you have the right to refuse the coverage. Refusing Part B coverage is an important decision to make, so please consider it wisely.
Consider these examples, to help you decide if you should keep Part B:
- I’m still working and have coverage through my employer. Or, my spouse is still working and I’m covered by his or her employer. Ask your employer or union benefits administrator if they require you to sign up for Part B. If your employer doesn’t require you to sign up for Part B right away, you can usually sign up for Part B later during a Special Enrollment Period without a late enrollment penalty.
- I’m retired and have coverage through a former employer, or I have COBRA or VA coverage. If you’re retired and have retiree health insurance from a former employer or union, or you have COBRA or U.S. Department of Veterans Affairs (VA) coverage, Medicare generally will become your primary health insurance. Medicare will pay its part of the costs for any health care services you get, and then any amount not covered by Medicare can be submitted to your non-Medicare plan. If you don’t keep Part B, your current coverage might not pay your medical costs during any period in which you were eligible for Medicare Part B, but didn’t sign up for it.
- I have coverage through the Health Insurance Marketplace as an individual or through an employer. If you have a Marketplace plan for individuals or families, you should keep Part B and drop your Marketplace plan so it stops when your Medicare starts. You won’t be eligible for premium tax credits or other savings for a Marketplace plan once your Part A coverage starts and you if you miss your enrollment period you will end up paying a penalty for enrolling late.
- I have TRICARE coverage (insurance for active-duty military, military retirees, and their families). You must have Part B to keep TRICARE coverage. However, if you’re an active duty service member or the spouse or dependent child of an active-duty service member, you may not have to get Part B right away.
- I have CHAMPVA coverage. You must have Part B to keep your CHAMPVA coverage.
- I have coverage through a private insurance plan. If you accept Medicare Part B, Medicare will pay its part of the costs for any health care services you get, and then any amount not covered by Medicare can be submitted to your private plan.
- I don’t have other health insurance. If you don’t have other health insurance, you should accept Part B if you want coverage for things like doctors’ services or preventive services.
Before you make any decisions about opting out of Part B, speak to the Social Security Administration (and keep detailed notes of each conversation).
For a more information about Medicare please read the booklet entitled Welcome to Medicare.